Prevalence and risk factors of systemic sclerosis-associated interstitial lung disease in East Asia: A systematic review and meta-analysis

Objective Interstitial lung disease (ILD) is a common and potentially life-threatening complication for individuals with systemic sclerosis (SSc). The purpose of this study was to complete a systematic review and meta-analysis on prevalence and risk factors of SSc-ILD in East Asia. Methods Medline, EMBASE, and Cochrane Library were searched up to January 22, 2021. The Reporting of Observational Studies in Epidemiology (STROBE) statement was applied to access the methodological quality of the eligible studies. Study characteristics and magnitude of effect sizes were extracted. Then, we calculated the pooled prevalence, weighted mean differences (WMDs), pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs), and performed subgroup analysis, sensitivity analysis, and publication bias with Egger's test. Results Twenty-seven of 1584 articles were eligible and a total of 5250 patients with SSc were selected in the meta-analysis. The pooled prevalence of SSc-ILD in East Asia was 56% (95% CI 49%-63%). The SSc-ILD prevalence was higher in China (72%) than in Japan (46%) and Korea (51%). Longer disease duration (WMD = 1.97, 95% CI 0.55-3.38), diffuse SSc (OR = 2.84, 95% CI 1.91-4.21), positive anti-topoisomerase I antibody (ATA) (OR = 4.92, 95% CI 2.74-8.84), positive anti-centromere body antibody (ACA) (OR = 0.14, 95% CI 0.08-0.25), positive anti-U3 ribonucleoprotein (RNP) antibody (OR = 0.17, 95% CI 0.04-0.66), and higher erythrocyte sedimentation rate (ESR) (WMD = 6.62, 95% CI 1.19-12.05) were associated with SSc-ILD in East Asia. Conclusion Through this systematic review and meta-analysis, we found that ILD occurs in up to approximately 56% of patients with SSc in East Asia. Longer disease duration, diffuse SSc, positive ATA, negative ACA, negative anti-U3 RNP antibody, and higher ESR were risk factors for SSc-ILD.